Know your options for Medicare Advantage Plans in Oklahoma and find out how to enroll.
TABLE OF CONTENTS
Medicare Advantage Plans, called Medicare Part C, are bundled plans that have been designed to be an all-in-one alternative to Original Medicare by providing the same coverage as Parts A and B. These plans frequently include additional benefits like prescription drug coverage. They may even provide benefits Original Medicare doesn’t offer, such as hearing, vision, and dental.
Since Medicare Advantage Plans are offered by private insurance companies, the coverage, costs, and additional benefits offered can vary by plan. The plans available also vary by location, with different county residents having access to different plans. As such, it’s important to research the plan options available in your area to ensure you get the best Medicare Advantage Plan available in Oklahoma.
Compare ratings of insurance companies offering Medicare Advantage Plans in Oklahoma:
|Insurance company||Medicare rating||AM Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|Aetna||4 stars||A||A+||2.5 to 4.5 stars||Fifth out of 10|
|Blue Cross Blue Shield||4 to 4.5 stars||A+||A+||Not rated||Sixth out of 10|
|Cigna||4 stars||A-||Not rated||2.5 to 4.5 stars||Seventh out of 10|
|Humana||4 stars||A-||A+||1.5 to 4.5 stars||Third out of 10|
|Kaiser||5||A||A-||4.5 to 5 stars||First out of 10|
|UnitedHealthcare||3.5 stars||A-||A-||4 stars||Fourth out of 10|
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
Routine vision exams with allowance for glasses
Routine dental exams
Hearing exams with allowance for hearing aids
Fitness and wellness programs and discounts
Transportation to medically necessary care
Over-the-counter (OTC) drugs
With 72 Medicare Advantage Plans available in Oklahoma, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
Oklahoma has 72 Medicare Advantage Plans available to its residents in 2022, including local health maintenance organization (HMO) plans, local preferred provider organization (PPO) plans, regional PPO plans, and private fee-for-service (PFFS) plans.
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
In Oklahoma, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
|HMOs||HMOs typically require that you receive all services from in network providers:
|PPOs||PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
|PFFS Plans||PFFS plans don’t require a primary care physician or referrals for specialists:
|SNPs||SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Oklahoma Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
Oklahoma-wide Medicare Advantage Resources
|Resource||Contact||How they help|
|Oklahoma Community Health
(Oklahoma State Department of Health)
|Phone: 800-522-0203||Provided by the OSDH, this link offers information related to the Community health Services Division for the state of Oklahoma|
|Oklahoma County Health Departments (Oklahoma State Department of Health)||Phone: 800-522-0203||Provided by the OSDH, a clickable listing by county of the services available for Oklahoma’s 77 counties|
|Oklahoma Health Care Authority||Phone: 800-987-7767||Oklahoma’s Medicaid Agency, it also provides links and information related to MySoonerCare, provider information, and healthcare updates|
|Oklahoma Human Services – Medicare||(405) 521-3679||A link that provides service information related to Medicare, including eligibility, fraud reporting, and assistance with premiums|
|Oklahoma Insurance Department||Phone: 800-522-0071||The main page for insurance issues for Oklahoma residents, including MAP issues|
|Oklahoma Insurance Department – Medicare Advantage||Phone: 800-522-0071||Provides Oklahoma residents with quick answers related to the Medicare Advantage program|
|Oklahoma Medical Assistance Program Partner Agencies||Phone: 800-763-2828
|Provides a list of Oklahoma-based agencies that work with MAP to help residents with any issues|
|Oklahoma Medical Board||Phone: 405-962-1400||A resource to use to find information about the licenses of the practitioners allowed to provide services to Oklahoma residents|
|Oklahoma Medical Facility Directory (Oklahoma State Department of Health)||Phone: 800-522-0203||Provided by the Oklahoma State Department of Health (OSDH), a printable, downloadable PDF featuring a directory of facilities and licensed and/or Medicare-certified practitioners|
|Oklahoma Medicare Assistance Program||Phone: 800-522-0071||Connects Oklahoma residents to the Senior Health Insurance Counseling Program (SHIP) to assist seniors with Medicare-related issues and Senior Medicare Patrol (SMP) to assist with waste, abuse and fraud issues|
|Oklahoma Medicare Supplement Plan Comparison of Benefits 2021||Phone: 800-752-9475
|A printable, downloadable PDF booklet that lists several Medicare Supplement Plans and MAP Drug Plans available to Oklahoma residents|
|Oklahoma Prescription Assistance||Phone: 405-815-5126
email: [email protected]
|Offers assistance to Oklahoma residents for prescription-related issue for all assistance programs, including MAP|
|Oklahoma Program of All-Inclusive Care for the Elderly||Phone: 800-987-7767||The Program of All-Inclusive Care for the Elderly (PACE) assists those with long-term care needs to assist them to live on their own as much as possible by providing quality, low-cost health care|
|Oklahoma Rehabilitation Services||Phone: 214-767-6423
email: [email protected]
|Focuses specifically on how Medicare affects those receiving Social Security Disability Insurance (SSDI) or Social Security retirement benefits related to Durable Medical Equipment (DME)|
Local Medicare Advantage Resources
|Resource||Contact||How they help|
|Canadian County Health Department (Oklahoma State Department of Health)||Phone: 405-354-4872||Provided by the OSDH, this is a link to the health services provided by the Canadian County Health Department|
|Grove City Medicare Open Enrollment Assistance||Phone: 918-253-4683||This is a link that provides free information via a phone number to Medicare Open Enrollment Assistance provided by the city of Grove, Oklahoma and the Northeast Oklahoma Community Action Agency|
|Logan County Health Department (Oklahoma State Department of Health)||Phone: 405-282-3485||Provided by the OSDH, this is a link to the health services provided by the Logan County Health Department|
|Oklahoma City Medicare Eligibility||Phone: 800-772-1213
email: [email protected]
|Frequently asked questions (FAQs) provided by the City of Oklahoma City related to Medicare eligibility for city residents|
|Oklahoma City SoonerCare Supplemental||(800) 987-7767||A page that provides brief information about Medicare (with a link) and detailed information about the Soonercare Supplement plan for Oklahoma City residents|
|Tulsa Health Department||Phone: 918-582-WELL (9355)||The homepage for the Tulsa Health Department|
Federal Medicare Advantage Resources
|Resource||Contact||How they help|
|CMS Medicare Managed Care Appeals & Grievances||Phone: 800-633-4227||Provided by the CMS, this page provides information related to dealing with Medicare managed care plan grievances and appeals|
|CMS Medicare Managed Care Eligibility and Enrollment||Phone: 800-633-4227||Provided by the Centers for Medicare & Medicaid Services (CMS), this page offers information for contacting MAP organizations plus other health plans and related aspects to Medicare health plan enrollment|
|CMS Medicare Prescription Drug Eligibility and Enrollment||Phone: 800-633-4227||Provided by the CMS, this page details prescription drug eligibility and enrollment as it relates to MAP|
|Medicare.gov||Phone: 800-633-4227||The homepage for the main Medicare website for the U.S|
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.